ADHD is a neurobehavioral condition that becomes apparent in preschool and early school years with symptoms that include excessive motor restlessness, poor attention, and impulsive acts. Estimates show that between 3 and 7 percent of school-aged children and about 4 percent of adults have ADHD.
There are three subtypes of ADHD: primarily inattentive type, primarily hyperactive/impulsive type, and that with significant symptoms of both (called combined subtype). Boys diagnosed with ADHD outnumber girls with the condition by about three to one
Core Symptoms of ADHD
Inattention: Impaired attention is manifested by prematurely getting off from tasks and leaving activities unfinished. The children change frequently from one activity to another, seemingly losing interest in one task because they become diverted to another. There is lack of persistence in tasks that require sustained mental effort like academics. The child pays Poor attention to details, makes careless mistakes, has Difficulty concentrating, Doesn’t seem to listen, Fails to follow through on instructions & finish work, Difficulty organizing work and self, Avoids,, dislikes lengthy, effortful tasks, Loses things, Easily distracted and Forgetful.
Hyperactivity: Overactivity implies excessive restlessness, especially in situations requiring relative calm like the classroom or other structured places like a market, doctors clinic, friends place. It may, depending upon the situation, involve the child running and jumping around, getting up from a seat when he or she was supposed to remain seated, excessive talkativeness and noisiness, or fidgeting and wriggling. The child has difficulty playing quietly, seems always on the go, driven by a motor, talks excessively.
Impulsivity: Disinhibition in social relationships, recklessness in situations involving some danger, and impulsive flouting of social rules (as shown by intruding on or interrupting others’ activities, prematurely answering questions before they have been completed, or difficulty in waiting turns.
Learning disorders and motor clumsiness occur with greater frequency. Hyperkinetic children are often reckless and impulsive, prone to accidents, and find themselves in disciplinary trouble because of unthinking (rather than deliberately defiant) breaches of rules. Their relationships with adults are often socially disinhibited, with a lack of normal caution and reserve; they are unpopular with other children and may become isolated. Cognitive impairment is common, and specific delays in motor and language development are disproportionately frequent.
Assessment and diagnosis
Assessment for ADHD/ADD is frequently requested by schools for attention deficit, impulsivity and hyperactivity in classroom interfering with school performance. Following assessment a plan is made for management with medication and/ or behavior management program. Formal diagnosis is based on validated medical classification systems DSM 5 or ICD 10.
Comprehensive ADHD Assessment typically includes clinical examination ( physical, behavioral), interview of patient, parent and teachers, direct behavioral observations, rating scales, intelligence testing, screening for learning disability. Evaluation helps to identify secondary problems associated with ADHD like conduct, self esteem, learning, relationships and helps to design a robust behavior intervention plan.
There is no brain imaging scan or blood test to diagnose ADHD.
TREATMENT OF ADHD
While there is NO CURE for ADHD treatment helps the child work towards their full potential. Behavioral Treatment has 3 pillars:
Parent Training: Helps parents learn about ADHD and ways to manage ADHD behaviours;
Child-Focused Treatment: Helps children and teens with ADHD learn to develop social, academic, organizational and problem solving skills;
School-Based Interventions: Help teachers meet children’s educational needs by teaching them skills to manage the children’s ADHD behaviors in the classroom (such as rewards, consequences, and daily report cards sent to parents).
Four programs are available for parents: the Triple P ( Positive Parenting Program), Incredible Years Parenting Program, Parent Child Interaction Therapy, New Forest Parenting Program.
Medication: Medication is a highly effective way to treat the symptoms of ADHD. ADHD medications are grouped into two major categories: stimulant and non-stimulant. Stimulant medications, such as methylphenidate and amphetamines, are highly effective treatments for ADHD and have been available for decades. The only FDA-approved non-stimulant medication, atomoxetine, also has been shown to be an effective treatment for ADHD.
Stimulant medication comes in short-acting and long acting forms. Short-acting stimulants are generally taken two to three times a day and last 4 to 5 hours per dose. Long-acting stimulants are usually taken once a day and last between 7 and 12 hours. The non-stimulant medication atomoxetine is usually taken as a single daily dose in the morning or as two divided doses in the morning and late afternoon or early evening.
Some parents worry that stimulant medication may make their child susceptible to addiction. This is a common misconception about ADHD medication.
The most common and predictable side effects from stimulant medication are reduced appetite, weight loss, problems sleeping, headaches, stomach pain, and irritability. These side effects usually get better within the first couple of months of treatment.
The non-stimulant atomoxetine also can cause nausea, reduced appetite, and weight loss. Some children complain of drowsiness or mild irritability during the day while taking this medication; however, these side effects usually go away after the first month of treatment.
In particular, you should tell the doctor about any heart or mental-health problems your child experiences while on ADHD medication and if there is a family history of these problems. Heart-related problems, hallucinations and agitation, suicidal thoughts, and liver problems are some of the rare and serious side effects people on ADHD medication may be at risk of developing.